Checking in from Northern California. I’m visiting family in the Bay Area for a good chunk of August (I packed in a bunch of ER shifts early in the month, and will get in a few more near the end of the month). I wouldn’t call this a vacation, because I’m working fairly intensely on research and writing most days, but it’s certainly a nice change of pace.
Is a doctor really taking a vacation if they have to work more days in a row to have several days in a row off only the end up working the same number of days during their month?
Every single vocation allows for true vacation days except for a few specialties in medicine.
Why are we not allowing our doctors to recharge like everyone else with a vacation where they receive reimbursement for not showing up to work and working fewer days during that month?
The business of medicine has learned to take it advantage of the passion that drives doctors. The same goes for publishers who obtain all scientific articles for free from the authors then charge subscribers for them.
"Every single vocation allows for true vacation days except for a few specialties in medicine."
That's not true for many people in professional services, and it is paradoxically worse the more and more senior and successful one becomes. As an example, law firm partners, especially in transactional practices, can't go dark without many weeks of preparatory work, and then only for a day or two at most. Most don't ever go dark.
ED physicians, who are predominately employees, never get paid vacation days. They have to show up for work to get paid and they have to work the same number of shifts every month of the year. I’ve never heard of them getting sick time either but some likely do.
While there are sacrifices when you are a lawyer in a partnership there’s also absolutely no requirement that you perform in-person professional services before a court on nights, weekends and holidays, which is the norm in emergency medicine. While it’s true lawyers work long hours they are not presenting cases after business hours. It’s a nonstarter to have a court appearance after 5 PM on a business day. Most judges have 6 weeks of vacation. Then there’s the point that all this legal work is going towards a large seven-figure contingency payout. There’s no contingency payout in medicine.
The comparison of lawyers to doctors is gross. Lawyers have less than half the education as physicians and rarely work for free and often won’t work without money up front. Every single emergency physician sees every single patient without requiring upfront payment.
I’m just asking why this group of physicians that maintains America’s social contract to providing life-saving care to all is so marginalized compared to their celebrated cardiology and surgery counterparts who are enjoying executive level employee benefits.
This is obviously outside of the scope of this substack, but you're operating under a variety of misunderstandings about how the legal profession works in the US in big law firms, and you may also not appreciate the very different practices between litigators who go to court and transactional lawyers who manage deals.
First, I'm not sure where you're coming up with lawyers having half the education as physicians. At the large law firms, nearly all attorneys attended top undergraduate schools and graduated near or at the top of their classes (4 years). They also earned a Juris Doctor degree from a top law school (call it generally top 20 law schools plus maybe an extra local law school in the city of the respective office) (3 years). Many lawyers, particularly transactional lawyers, have an extra degree, for instance a "masters" (LLM) degree in tax (1 year). Personally, I earned an MBA in addition to my JD in a 4 year JD/MBA program. I'm not sure how my 8 years of undergraduate and graduate education is any less than a physician's.
It's a cliche, but it's also true that half of the people who go to law school would have considered going to med school but for the fact that they were going to fail o chem.
Following graduation, an attorney is an associate for typically 8-10 years before being considered for promotion to partner at a big law firm, a training process that is not philosophically that much different than a residency/fellowship process in medicine. Depending upon the firm, probably about 15-20% of associates make partner. If they're not promoted, they typically have to find another job. I *will* freely admit that law firm associates are vastly better compensated than residents/fellows, but I can't fix health care economics.
In terms of hours, you must not know any attorneys. While you're correct that courts are only in session from 9-5, only about 5% (at most) of a litigator's time is actually spent in court. Late nights and long weekends are the rule, and during trial, litigators are often away from their families for many weeks and even months at a time. It's part of why the divorce rate is so high for litigators.
Even on the transactional side, 12+ hour days are the rule (we check our email first thing on waking and again last thing in bed, so it's often 16-18 hour days), and all-nighters are not unusual when a deal is being signed, even for the partners. That's especially true for hose who work on international transactions. Also, firms expect a certain level of intensity from their partners. If we haven't recorded at least 2600 hours (50 hours a week for 52 weeks) of activity at the end of the year (not just billable time, but all hours in support of the firm), the firm will hit us in the pocketbook. Associates often have minimum billable hours that exceed 2000 hours a year. Many firms don't give associates specific vacation days, they just take off time when they believe they can. Partners definitely don't have specific vacation days. We also don't get sick days. By the time partners hit a certain age, every single one of them has a story about answering client emails and phone calls while sitting on a gurney in an ED or in a hospital bed. I once had to attend a board meeting telephonically with my left hand suspended in the air while I was an inpatient on IV antibiotics after an animal bite went bad.
Most importantly for partners (especially the senior partners), we have to generate the paying business ourselves and maintain the relationships with clients for years. For partners, that means we never get to go dark. When our clients want something, we have to be there for them, because if we aren't they'll find another lawyer who will be, and if we don't have a meaningful book of business, we're gone.
To be clear, I'm not trying to equate the social "value" of attorneys to that of physicians. There's no question that being a physician is an infinitely higher calling than being an attorney.
That said, I was initially responding to your comment that "Every single vocation allows for true vacation days except for a few specialties in medicine." That's not a true statement, nor is it a true statement that physicians have twice the education that lawyers do or that lawyers work less than emergency medicine physicians.
Based on my experience, I think you'll also find that if you compare attending physicians coming out of top 20 undergraduate and medical schools with partners at law firms who graduated from the same undergraduate and related law schools, they're pretty similarly driven personalities and probably dated people in common in college...
Not being able to read about the "sausage making" real-time doesn't bother me. That level of disclosure sensitivity for research is no different than the limitations you have about disclosing information about patients. It's part of the gig.
Maybe keep a side notebook of things that you would like to talk about but can't *yet* and periodically revisit that notebook so that you can do a grab bag post later on? It could become a recurring monthly feature or something like that.
There are many benefits of the peer review process, but there are also challenges. This may be an excellent topic to write about. Have a great weekend!
Is a doctor really taking a vacation if they have to work more days in a row to have several days in a row off only the end up working the same number of days during their month?
Every single vocation allows for true vacation days except for a few specialties in medicine.
Why are we not allowing our doctors to recharge like everyone else with a vacation where they receive reimbursement for not showing up to work and working fewer days during that month?
The business of medicine has learned to take it advantage of the passion that drives doctors. The same goes for publishers who obtain all scientific articles for free from the authors then charge subscribers for them.
"Every single vocation allows for true vacation days except for a few specialties in medicine."
That's not true for many people in professional services, and it is paradoxically worse the more and more senior and successful one becomes. As an example, law firm partners, especially in transactional practices, can't go dark without many weeks of preparatory work, and then only for a day or two at most. Most don't ever go dark.
ED physicians, who are predominately employees, never get paid vacation days. They have to show up for work to get paid and they have to work the same number of shifts every month of the year. I’ve never heard of them getting sick time either but some likely do.
While there are sacrifices when you are a lawyer in a partnership there’s also absolutely no requirement that you perform in-person professional services before a court on nights, weekends and holidays, which is the norm in emergency medicine. While it’s true lawyers work long hours they are not presenting cases after business hours. It’s a nonstarter to have a court appearance after 5 PM on a business day. Most judges have 6 weeks of vacation. Then there’s the point that all this legal work is going towards a large seven-figure contingency payout. There’s no contingency payout in medicine.
The comparison of lawyers to doctors is gross. Lawyers have less than half the education as physicians and rarely work for free and often won’t work without money up front. Every single emergency physician sees every single patient without requiring upfront payment.
I’m just asking why this group of physicians that maintains America’s social contract to providing life-saving care to all is so marginalized compared to their celebrated cardiology and surgery counterparts who are enjoying executive level employee benefits.
Darin -
This is obviously outside of the scope of this substack, but you're operating under a variety of misunderstandings about how the legal profession works in the US in big law firms, and you may also not appreciate the very different practices between litigators who go to court and transactional lawyers who manage deals.
First, I'm not sure where you're coming up with lawyers having half the education as physicians. At the large law firms, nearly all attorneys attended top undergraduate schools and graduated near or at the top of their classes (4 years). They also earned a Juris Doctor degree from a top law school (call it generally top 20 law schools plus maybe an extra local law school in the city of the respective office) (3 years). Many lawyers, particularly transactional lawyers, have an extra degree, for instance a "masters" (LLM) degree in tax (1 year). Personally, I earned an MBA in addition to my JD in a 4 year JD/MBA program. I'm not sure how my 8 years of undergraduate and graduate education is any less than a physician's.
It's a cliche, but it's also true that half of the people who go to law school would have considered going to med school but for the fact that they were going to fail o chem.
Following graduation, an attorney is an associate for typically 8-10 years before being considered for promotion to partner at a big law firm, a training process that is not philosophically that much different than a residency/fellowship process in medicine. Depending upon the firm, probably about 15-20% of associates make partner. If they're not promoted, they typically have to find another job. I *will* freely admit that law firm associates are vastly better compensated than residents/fellows, but I can't fix health care economics.
In terms of hours, you must not know any attorneys. While you're correct that courts are only in session from 9-5, only about 5% (at most) of a litigator's time is actually spent in court. Late nights and long weekends are the rule, and during trial, litigators are often away from their families for many weeks and even months at a time. It's part of why the divorce rate is so high for litigators.
Even on the transactional side, 12+ hour days are the rule (we check our email first thing on waking and again last thing in bed, so it's often 16-18 hour days), and all-nighters are not unusual when a deal is being signed, even for the partners. That's especially true for hose who work on international transactions. Also, firms expect a certain level of intensity from their partners. If we haven't recorded at least 2600 hours (50 hours a week for 52 weeks) of activity at the end of the year (not just billable time, but all hours in support of the firm), the firm will hit us in the pocketbook. Associates often have minimum billable hours that exceed 2000 hours a year. Many firms don't give associates specific vacation days, they just take off time when they believe they can. Partners definitely don't have specific vacation days. We also don't get sick days. By the time partners hit a certain age, every single one of them has a story about answering client emails and phone calls while sitting on a gurney in an ED or in a hospital bed. I once had to attend a board meeting telephonically with my left hand suspended in the air while I was an inpatient on IV antibiotics after an animal bite went bad.
Most importantly for partners (especially the senior partners), we have to generate the paying business ourselves and maintain the relationships with clients for years. For partners, that means we never get to go dark. When our clients want something, we have to be there for them, because if we aren't they'll find another lawyer who will be, and if we don't have a meaningful book of business, we're gone.
To be clear, I'm not trying to equate the social "value" of attorneys to that of physicians. There's no question that being a physician is an infinitely higher calling than being an attorney.
That said, I was initially responding to your comment that "Every single vocation allows for true vacation days except for a few specialties in medicine." That's not a true statement, nor is it a true statement that physicians have twice the education that lawyers do or that lawyers work less than emergency medicine physicians.
Based on my experience, I think you'll also find that if you compare attending physicians coming out of top 20 undergraduate and medical schools with partners at law firms who graduated from the same undergraduate and related law schools, they're pretty similarly driven personalities and probably dated people in common in college...
Not being able to read about the "sausage making" real-time doesn't bother me. That level of disclosure sensitivity for research is no different than the limitations you have about disclosing information about patients. It's part of the gig.
Maybe keep a side notebook of things that you would like to talk about but can't *yet* and periodically revisit that notebook so that you can do a grab bag post later on? It could become a recurring monthly feature or something like that.
There are many benefits of the peer review process, but there are also challenges. This may be an excellent topic to write about. Have a great weekend!